During a typical percutaneous transluminal coronary angioplasty (PTCA) procedure, a balloon catheter is transported to a stenotic region in an artery or related body lumen. Normally a balloon for PTCA has an oblong, cylindrical shape with a single chamber that can be inflated to open up the arterial passageway. Once the lumen has been opened up, the balloon is deflated and removed through the same path by which it entered. If an uninflated balloon is to be easily placed inside and transported through an anatomical lumen, such as a curved artery, it must be flexible enough to be able to follow the lumen curvature, while maintaining enough rigidity to avoid bunching up during its passage to the desired endoluminal location. Conventionally, a relatively rigid guide wire can be used to effect balloon placement. Once the balloon has been inflated, its flexibility problem becomes much more profound, as the balloon is now often too rigid to bend in conformance with the lumen wall. Such a balloon will have the tendency to straighten itself upon inflation, thus creating undesirable forces on the inner wall of the lumen.
In some situations, the chance for restenosis of a body lumen that has been dilated can still be great. To avoid the necessity of repeated PTCA procedures, the doctor will implant an endoluminal prosthesis, also known as a stent, into the patient""s body lumen adjacent the stenotic region. The stent is intended as a permanent or semi-permanent structure that maintains an open passageway, thereby reducing the chance for restenosis. Typically, the stent is balloon expandable, and is mounted around the balloon, such that both can be inserted simultaneously. If the stent has to be placed into a curved section of the body lumen, it too will take this straightened shape from the expanding single chamber balloon, which could lead to possible puncture or similar damage to the lumen wall. Additionally, the inappropriate fit between stent and lumen wall could allow the stent to loosen and migrate to a different part of the lumen.
Rigid expansion of the balloon can cause other problems to occur as well. For example, during angioplasty, the balloon is inflated to such an extent that the lumen in which the balloon is placed becomes temporarily plugged. While this is not critical for rapid angioplasty or stent deployment procedures, or is not feasible with very small or very high pressure devices (such as in a carotid artery, where the lumen diameter is typically between 2.5 and 4 millimeters), it is of concern for devices used in larger cross-sectional area lumens, such as a patient""s leg or aorta, where lumen diameters can be from approximately 8 to 25 millimeters. If the inflated balloon obstructs blood flow for too long (typically for more than a few seconds), permanent damage to downstream organs can occur due to ischemia, which is the cessation of blood flow through the lumen. Accordingly, it is often desirable to keep the patient""s blood flowing through the lumen while the balloon is in the inflated state. This is preferable to cycling the balloon between an inflated and deflated state, as such action can place additional stress on an already compromised lumen wall.
Multiple chamber balloons have been introduced into the art to meliorate the difficulty in transporting relatively rigid catheters into body lumens with tortuous paths. For example, U.S. Pat. No. 5,019,042 to Sahota, and U.S. Pat. No. 5,415,635 to Bagaoisan et al. both describe multiple lobed balloon catheters that have one set of lobes that expand more than other sets. Similarly, the introduction of perfusion balloons, so named because of an open channel that extends through or around the balloon to permit continuous flow of blood, has partially solved the ischemia dilemma. Examples of perfusion balloons are described in U.S. Pat. No. 5,613,948 to Avellanet, and U.S. Pat. No. 4,909,252 to Goldberger, both of which include a perfusion channel extending axially through a single-chamber balloon with eccentrically mounted expansion fluid supply. There have additionally been attempts to combine perfusion features with flexible, multiple chamber balloons, as evidenced by some of the aforementioned patents. However, the size of the apertures leading into and out of the perfusion channel is such that blood throughput can be unacceptably low, which limits the amount of time the doctor has to perform the PTCA procedure, as well as create a pressure gradient that could assist in pushing the balloon farther downstream than intended. In addition, the relatively large profile of the uninflated assembly makes transport through small or highly curved body lumens difficult, while the multiple layers found in present balloon catheter construction make for expensive, damage-prone devices.
What is needed is a balloon catheter that can be hinged while inflated to better conform to the shape of the lumen in which it is disposed. What is additionally needed is a flexibly compliant balloon catheter that can mimic the shape of a path formed by a body lumen while the catheter is uninflated, thereby enhancing the ability of the catheter to be inserted into curved, tortuous lumen paths. What is furthermore needed is a balloon catheter of such construction that fabrication difficulties and susceptibility to damage are meliorated. What is also needed is a flexible balloon catheter that can maintain blood perfusion, even when the catheter is in its inflated configuration, and even when disposed in a curved or tortuous part of a body lumen.
These needs are met by the present invention, whereby a flexible balloon catheter according to the present invention is made of a series of short inflatable chambers in fluid communication with one another through connection to a common core that can transport a pressurized fluid to the chambers. In the context of the present invention, the term xe2x80x9cflexiblexe2x80x9d and its variants is meant to convey that it is easier for the balloon (either expanded or unexpanded) to bend in flexure, or normal to its axial dimension, while traversing a curved body lumen than it would be if the multiple chambers and compliant link/hinge sections herein described were not employed. Similarly, the terms xe2x80x9cinflatablexe2x80x9d, xe2x80x9cexpandablexe2x80x9d and their variants are used interchangeably throughout this disclosure to describe the ability of the balloon (and its separate chambers) to enlarge in response to the presence of a pressurized fluid. Even upon balloon inflation, the connections between the balloon""s numerous short chambers remain compliant enough to follow the natural curvature of the lumen, without other forces than radial pressure against the inner wall of the artery. Balloon insertion through the tortuous paths associated with anatomical lumen becomes much more reliable, thereby significantly reducing the risk for damaging the lumen. Further, when the balloon is used in conjunction with a prosthetic stent, it becomes possible to place a longer stent in such a curved lumen, with the added assurance that after inflation the stent will be deployed following the natural curves of the lumen.
It is therefore an object of the invention that a balloon for angioplasty is made in short sections (or chambers) compliantly linked therebetween in order to improve the flexibility and adaptability in both the deflated as well inflated state such that the tendency of the sectioned balloon to straighten during inflation is reduced, thus improving its insertability into a curved body lumen.
It is a further object of the present invention to vary the length of the compliant links between each of the chambers so that flanges that make up the chamber side walls need not be spaced substantially parallel to its immediate neighbor on an adjacent chamber, thus permitting additional axial room, and hence flexibility, without changing the outer geometry of the inflated balloon assembly.
It is still another object of the present invention to provide a balloon catheter that includes a series of discrete ring- or donut-shaped balloon chambers, each with a large central aperture and mounted on a common pressurizable fluid delivery core, thus allowing blood perfusion through the center of the balloon in both its uninflated and inflated states.
It is an additional object of the present invention to provide a perfusion balloon made up of discrete chambers that individually include a perfusion aperture and together make up a substantially flexible, hollow perfusion canal that can allow at least one other additional catheter to pass therethrough to be used for a different procedure such as for distal protection against emboli, for distal angioplasty and/or stenting, for pressure monitoring or any other related treatment, or additional treatment methods, such as ultrasonic, radiation, laser, thermal or related procedure.
It is still another object of the present invention that individual balloon sections of a flexible balloon catheter are covered with a flexible liner or sleeve to tailor surface smoothness, reduce the deflated size, control the friction between the sleeve and an inserted stent, increase the speed of deflation, control the timing of inflation over the length or influence the final dimensions during and after inflation, or to get a more even radial pressure to a lumen wall.
An additional object of the present invention is that the outer wall of the segmented perfusion balloon or the liner or sleeve surrounding the individual balloon chambers is provided with drugs that can be released with a controlled speed in order to treat the inner wall of the lumen locally during a given period.
Yet another object of the invention is the production of segmented balloons by sealing two layers of polymer sheet in a specific pattern, which determines the dimensions, position, and flexibility of the final inflatable and non-inflatable sections. Parts of the sealed sections can be cut away to create hinges for additional flexibility.
Another object of the invention is to provide a segmented balloon catheter where the dimensions and arrangement of the connecting channels between the adjacent donut-shaped balloon chambers are chosen so that inflation of the device performs in a gradual way, where an inflation gradient runs from the proximal to the distal end, which can permit the placement of a stent to also become more gradual and therefore controllable when combined with such a segmented balloon.
According to a first embodiment of the invention, a balloon for use as a surgical device in a body lumen is disclosed. The balloon includes an axially elongate tubular core with a plurality of expandable chambers disposed on the outer surface thereof, and a plurality of flexibly compliant links disposed between adjacent chambers. The core is further defined by a proximal end configured to be in fluid communication with a pressurizable fluid source, and a distal end. The hollow central region of the tubular core extends between the proximal and distal ends, and includes a plurality of apertures disposed on its outer radial surface such that each aperture defines a fluid communication path between the hollow central region and the outer surface of the core. The apertures are configured such that they are substantially axially spaced upon balloon expansion. As used in conjunction with the present disclosure, the term xe2x80x9csubstantiallyxe2x80x9d refers to an arrangement of elements or features that, while in theory would be expected to exhibit exact correspondence or behavior, may, in practice embody something slightly less than exact. For example, the enhanced flexibility of the present invention balloon catheter in its inflated condition allows the outer surface of the catheter to xe2x80x9csubstantiallyxe2x80x9d engage the inner wall of a body lumen into which it is placed, even if the lumen is curved or irregular. Thus, by substantially engaging the lumen inner wall, a majority of the catheter""s outer surface designed to contact the lumen inner wall will in fact do so upon proper insertion and inflation, rather than establishing contact at only a few discrete places. The chambers are disposed on the outer surface of the tubular core such that each chamber is in fluid communication with the hollow central region through at least one of the radial apertures. The flexibly compliant links connect each of the chambers to one another as well as to the outer surface of the tubular core. The flexibly compliant links, which may comprise the portion of the core disposed between adjacent chambers or be a separate hinge structure mounted onto the core, by virtue of their small cross-sectional profile relative to the expanded chambers, effect improved flexibility of the balloon by breaking up the rigidity of an otherwise single elongate chamber.
Optionally, the sections making up the flexibly compliant links or hinges can be made longer or shorter to tailor the flexibility to specific needs. In situations where the flexibly compliant link is a hinge, the hinge may be an integral, continuous connection between adjacent chambers, or fabricated from joined disparate members. Preferably, the material used for the chambers and hinges is of substantially constant thickness throughout. Each of the plurality of chambers can be defined by an outer surface that comprises a body lumen inner wall engaging portion and a pair of flange portions that extend between the body lumen inner wall engaging portion and one of the hinges. In addition, the individual chambers can be enveloped within a flexible sleeve to promote a uniform expanded profile. In the present context, the radially outward surface of each chamber, referred to herein as the xe2x80x9cbody lumen inner wall engaging portionxe2x80x9d (and minor variants thereof) is defined to include not only direct surface-to-surface contact between this surface and the lumen inner wall, but also where an optional sleeve (discussed in more detail below) is placed around one or more of the chambers to prevent direct contact, as long as such addition is not significantly disruptive of the ability of those chambers to expand the lumen in accordance with their PTCA function. As another option, each of the hinges can possess an axial length such that upon balloon inflation, opposing flanges between axially adjacent chambers are substantially parallel to one another. In the alternative, the hinges possess an axial length such that, upon inflation of the balloon, opposing flange portions between axially adjacent chambers are farther apart near the body lumen inner wall engaging portion than they are near the hinge. As another alternative option, the hinges possess an axial length such that, upon balloon inflation, opposing flange portions between axially adjacent chambers are farther apart near the hinge than they are near the body lumen inner wall engaging portion. Moreover, drugs (such as restenosis inhibitors), a stent device and a chamber-enveloping sleeve, or any combination of the three, may optionally be included.
According to a second embodiment of the invention, a surgical device assembly for insertion into a body lumen is disclosed. This embodiment includes, in addition to the features of the previous embodiment, a guide wire configured to assist in transporting the balloon through the body lumen; and an expandable stent disposed over the balloon. This stent can balloon expandable or self-expanding, the latter including shape-memory materials such as nickel-titanium. Also, the axially elongate tubular core and expandable chambers can be made from a single piece of material. As with the first embodiment, drugs (such as restenosis inhibitors), a stent device and a chamber-enveloping sleeve, or any combination of the three, may optionally be included.
According to a third embodiment of the invention, a perfusion balloon for use as a surgical device is disclosed. The balloon includes a plurality of expandable ring (or donut)-shaped chambers configured to be substantially axially aligned upon inflation, a chamber connecting channel is coupled to the plurality of chambers, and a hollow central region extending from a proximal end to a distal end of the balloon. Each of the chambers includes a flange portion made up of a proximal flange and a distal flange that are substantially axially aligned with one another when the chamber is expanded, as well as a generally circumferential body lumen inner wall engaging portion disposed between the proximal and distal flanges of the flange portion. A proximal end of the channel is configured to be in fluid communication with a pressurizable fluid source. Inherent in any ring-like structure is a centrally disposed aperture; in the present embodiment, the centrally disposed aperture of each of these ring-shaped chambers allows blood perfusion therethrough, even during full balloon inflation. Such a design combines the feature of improved axial adaptability with the low resistance to blood flow to promote treatment without the dangers of occlusion. Moreover, the risk of undesirable axial displacement of the balloon by the blood pressure is reduced, since there is not a large pressure drop along the length of the balloon. In addition, due to the radially outward pressure exerted by the blood perfusion, the balloon may stay inflated for longer periods.
Optionally, the chamber connecting channel is integral with the chambers, thus resulting in simplified, one-piece construction between the two. Another option is that the perfusion balloon includes numerous balloon interchamber webs, each disposed between and coupled to adjacent chambers such that the webs provide enhanced balloon flexibility. In addition, each of the webs can be fluidly isolated from the pressurizable fluid source. The flexibility of the balloon can be further enhanced by radially projecting cutouts taken from the web. As with previous embodiments, the flexibility can be tailored by varying the axial length and geometry of the web. Additionally, the dimensions of the connecting channel can be configured to promote an inflation gradient between the proximal and distal ends of the balloon, thereby providing axial variations in the amount of expansion between chambers. In addition, the interconnection of the individual chambers is accomplished by direct coupling of the channel, rather than through a hinge. As another option, the relatively large perfusion canal, made up of the individual perfusion apertures, can accommodate one or more axially concentric sets of balloon catheters therethrough. Thus, a smaller catheter is capable of passing through the apertures of the larger due to the latter""s ring-like nature. This smaller catheter may be used for a second procedure behind the first angioplasty area of the perfusion balloon, which then functions as a flexible, hollow, working channel with an inflatable wall. Uses for the second, smaller catheter can include, for example, distal protection against emboli and related particulate matter, additional distal angioplasty and/or stenting, pressure monitoring, or other procedure. This concentric catheter approach also allows additional treatment within the first angioplasty area occupied by the perfusion balloon. For example, the second catheter can be disposed inside the perfusion balloon to conduct ultrasonic, radiation, laser, thermal or other related treatment. Other options include the ability of the catheter to accept drugs, for example, a drug that would inhibit restenosis, or a stent for a more permanent repair of the body lumen.
According to a fourth embodiment of the invention, a method of performing a PTCA with an improved flexibility balloon catheter is disclosed. The method includes the steps of inserting a balloon catheter into a body lumen, advancing the balloon catheter through the body, positioning the balloon catheter adjacent a predetermined location within the body lumen (such as a lesion), and inflating the plurality of expandable chambers. The balloon is configured according to the first and second embodiments described above. The improved flexibility attendant to the separate chambers separated by the flexibly compliant links ensures that the path formed by the lumen will be mimicked by the balloon catheter, even if the path is a tortuous, curved one. This promotes better balloon traversal during the uninflated insertion stage, as well as the improved ability to have a larger portion the balloon catheter engage the inner wall of the body lumen once it has been placed and inflated. As with the first two embodiments, drugs, a stent device and a chamber-enveloping sleeve, or any combination of the three, may optionally be included.
According to a fifth embodiment of the invention, a method of performing a PTCA with an improved flexibility perfusion balloon catheter is disclosed. The method includes the steps of inserting a perfusion balloon catheter into a body lumen, advancing it through the body lumen such that curvature, if any, in the body lumen is mimicked by the perfusion balloon catheter, positioning the perfusion balloon catheter adjacent a predetermined location within the body lumen (such as a lesion), and inflating the perfusion balloon catheter. The configuration is similar to that of the aforementioned third embodiment, where a relatively large perfusion aperture is disposed in donut-like (or ring-like) fashion in each chamber. Axial alignment of the numerous chambers, with their apertures therein, forms a perfusion canal to permit the continued flow of blood, even during balloon inflation. Optionally, drugs and/or stents can be included. In addition, the connection between the channel carrying the pressurized fluid and the flange of the chambers can be integral to promote simple, one-piece construction.